Achievement of Expectations and Functional Impact of the Hero Arm Bionic Hand Prosthesis in Children with Congenital Below-Elbow Deficiency: A Retrospective, Cross-sectional Study

ABSTRACT Background The Hero Arm bionic prosthesis was designed taking into account characteristics that are important to wearers, such as comfort, battery life, cosmesis, and functionality. Whether the Hero Arm meets the expectations of children with congenital below-elbow deficiency (CBED) is not known. Objective The aim of the study was to evaluate 1) whether the Hero Arm met children’s expectations, 2) grasp and functional ability with the prosthesis, and 3) prosthesis use in daily life. Study design This is a retrospective, single-center, cross-sectional study. Methods The Canadian Occupational Performance Measure (COPM) evaluated expectations, the Action Research Arm Test (ARAT) and the 400-Point Test evaluated grasp and functional ability, and a custom-made questionnaire evaluated satisfaction. Evaluations were conducted ≥12 months after fitting. Results Six children were included (4 girls, median age 12 [12–14] years). They stated 23 important activities they wanted the Hero Arm to assist. Mean COPM performance rating was ≥5/10 points for 17 activities and satisfaction ≥5/10 points for 19 activities. Median ARAT score was 54/57 [54–54]. Median unimanual 400-Point Test score was 57.5 [47.1–72.9] and time was 291 [226–382] seconds with the prosthesis vs. 63 [35–67] seconds with the other hand. Bimanual score was 87.5% [79.1–89.6]. Overall satisfaction with the Hero Arm prosthesis was 9/10 [8.25–9]. Two children stopped using the prosthesis, two used it <1 hr/d and two used it >1 hr/d. Conclusions The variability in the level of expectations met and functional ability with the prosthesis show that technical progress is required. Involving the child and family is essential when prescribing the Hero Arm prosthesis to ensure it meets the child’s goals. Clinical Relevance Statement The Hero Arm prosthesis allows children with congenital below-elbow deficiency to perform or enhance performance of specific activities. To improve usability, prosthesis weight needs to be reduced, and finger movement smoothness and speed must be increased.